Two years ago, we published a report on the promise of open APIs in healthcare. In APIs for a Healthcare App Economy: Paths to Market Success (available as a free download), provider organizations told us that developing and using APIs was low on their list of priorities. Modern REST-style APIs were still not on the radar for most providers and payers.

Back then, HCOs large and small said they expected their EHR vendor to build an API infrastructure for them. Two years ago, only Allscripts and athenahealth offered an app store along with a comprehensive developer support program. At that time, the other EHR vendors were slow-walking FHIR support and had vague plans for app stores and developer support programs. We found that:

Small HCOs were completely dependent on their EHR vendor.

EHR data was the most valuable data resource in healthcare.

Large IT vendors had varied beliefs about the role and contribution of third-party developers.

Large and small IT vendors had strong faith in open APIs.

Small and independent IT vendors were thinking way beyond the EHR.

Physician dissatisfaction with EHRs was an unsolved problem.

Since then, market conditions have continued to change. EHR vendors are now more vocally rolling out the API infrastructures that will bring healthcare into the mainstream of 21st century computing. Every major EHR vendor has delivered a variety of proprietary, HL7, FHIR, and SMART APIs along with the ability to leverage REST to improve their products.

Each of these companies sponsor, or will soon sponsor, an app store for third-party innovation. This has seen a concurrent rise in interest for using APIs within provider organizations. A recent Chilmark report, Healthcare App Stores: 2018 Status and Outlook, examines some of these platforms and the progress that has been made to date in more depth.

That said, some things have not changed. EHR data remains the most valued data resource in healthcare. All but the largest provider organizations are dependent on their EHR vendor for API enabling technologies. Small and independent developers struggle to participate in app stores and EHR developer support programs, despite great ideas for better apps to improve care delivery. And physician frustration with EHRs continues to grow.

Developing and using APIs is a priority for healthcare stakeholders who want to get more from their EHR investments as they identify opportunities for workflow improvements, real-time analytics dashboards, and more. While EHR vendors are leading the charge, our more recent research suggests that many other stakeholders hold or control access to other key data sources that could underpin such efforts.

The opportunity to capitalize on data already collected to provide advice and predictions is too big to ignore, and the easiest way to do this efficiently will be with integrated apps that can pull data from any relevant resource to provide the necessary insights at the right time.

Where do we go from here?

The number of apps in EHR app stores grows monthly. To date, the idea of the potential role and benefits of an independent certification body has not entered the discussion about APIs and app stores since the collapse of Happtique’s efforts in 2013. Currently, EHR vendors certify apps for their customers based on rigorous internal evaluations, but the process varies by vendor. An independent and impartial body could do more than just provide information for prospective users. Instead, it could deliver tremendous value if its assessments were multi-pronged and supplied information about the ongoing use of the app, as well as a consistent way to think about safety, security and dependability. While a certification authority could make it easier for decision-makers, the real value could be in delivering users more information about how the app delivers value across its install base.

Sometime in the next few months, the ONC will issue new rules on information blocking and what constitutes an API that does not require “special effort” to access and use. While these actions may seem like a watershed moment for health IT, the provider market has moved perceptibly since ONC began its rulemaking. Just two years ago, providers were curious about APIs and app stores but they weren’t ready to make any commitments.

Slowly and inexorably, healthcare is embracing the downloadable app as a tool for innovation and improvement. One-size-fits-all platforms are not meeting the needs of the industry and apps can do more to assist with care provision needs than just provide supplemental functionality – to read more about opportunities for apps to have significant impact, take a look at the infographic we developed to accompany our more recent report, or read more in this deep dive post from June.

The opportunity to capitalize on data already collected to provide advice and predictions is too big to ignore, and the easiest way to do this efficiently will be with integrated apps that can pull data from any relevant resource to provide the necessary insights at the right time.

To accompany the release of our new report, Healthcare App Stores: Statues and Outlook, we have also created this infographic presenting options and opportunities from EHR vendor-hosted app stores (the most common and robust type of app store-host), as well as the most promising alternatives.

Most healthcare apps are designed for consumers and available on consumer-oriented platforms like Google Play and Apple’s App Store. As EHR vendors ramp up their app stores, more healthcare workers will have access to apps, and patients will get better apps that integrate all their health data.

Currently, healthcare organizations prefer to rely on their EHR vendor to “approve” independently developed apps and ensure that the apps will interact well with their EHR, the center of any provider’s IT infrastructure. Among existing vendor apps, many meet the reference needs of patients and/or clinicians, particularly around education and training. In time, apps that support the transactional needs of both will become more numerous — especially referrals, decision support, and inter-organizational workflows.

So far, most vendor apps are aimed at specialty and primary care settings. To match the growth of health IT adoption and its role in enabling coordinated care among various settings, skilled nursing facilities, ambulatory pharmacy, and home health settings are best poised to benefit from vendor-hosted app stores.

Many types of companies hold patient data, and EHR vendors should not be the only or dominant sponsors of app stores in healthcare. Data intermediaries, such as the companies below, already support complex transactions with large amounts of patient data, are connected to healthcare enterprises via portal or application integration, and possess strong IT capabilities. With their own app store platform, they could present a serious challenge to EHR vendor dominance in this emerging market. Either way, patients and clinicians stand to benefit from wider app development and use, no matter where they are hosted.

To receive your own high-resolution version of the full infographic, please submit your email below:

Ok, before I even begin, let me put it right out there: I’ve been using Apple products since I first got my hands on one of those cute little Mac SEs in the late 80’s having given up my spanking, brand new Compaq 386 with 64kb of RAM and a dual 3.5 & 5.25 floppy drives to a post doc at MIT who traded me the Compaq, which he needed to finish his thesis, for his Mac. I never looked back. I will attempt to keep that bias in check in this post.

Tomorrow, Apple will formally release the iPad 2, a device that has seen extremely strong adoption in the healthcare sector and even one of the HIT industry’s leading spoke persons, John Halamka of Boston’s Beth Israel Deaconess Hospital (he’s also Harvard Med School’s CIO) spoke to the applicability of the iPad in the healthcare enterprise in the formal iPad 2 announcement last week.

The iPad 2 release is happening while most other touch tablet vendors including HP, RIM, Cisco and those building Android-based devices struggle to get their Gen 1 versions into the market. Of these other vendors, only Android-based devices are available today, including among others the Samsung Galaxy and the Motorola Xoom.

But it is not so much the new features in the iPad 2 (e.g., lighter weight, faster processor, two cameras, etc.) that will continue to make the iPad the go to device for physicians and healthcare enterprises, it is the process by which Apple vets and approves Apps that are available in the App Store. Apple imposes what at times for many App developers is an arduous and at times capricious approach to approving Apps. This approval process is in stark contrast of the one for Android, which is based on an open, free market model letting the market decide as to which Apps will succeed and which will not.

Virtually any patriotic, flag-waving American will say Hoorah, the free market rules. Of course a lot of App developers are saying the same thing and have riled against the Apple process since the first iPhone release back in 2007. But the free market, even here in America is truly not free. We have put laws and regulations in place, be they environmental, public health, etc. to protect the broader public good. Apple has done much the same for its App Store insuring that those Apps which are approved are unlikely to cause harm, which on a mobile device is usually the release of personal information such as passwords, credit card information, etc.

Unfortunately, the same can not be said for the Android OS and its marketplace of Apps. There have been numerous reported cases of malware Apps in the Android Market that most often are not removed until after thousands of users have had their personal information compromised. The latest occurred a little over a week ago when Google removed 21 malware Apps from the marketplace and then proceeded to remove about 30 more.

In the healthcare enterprise market, where very sensitive patient information is gathered and shared for improving the quality and efficiency of care delivered, touch tablets are seen as an ideal form factor for the ever on the move clinician who is looking to access the latest patient information at the point-of-care. Therefore, as clinicians increasingly demand access to such information via their touch tablet device, healthcare IT executives will increasingly seek to insure that the devices used are truly secure. Google’s continuing struggles to keep its Android Market free of malware will prevent devices using this OS from seeing greater adoption in the healthcare enterprise. This will allow Apple to continue to put distance between itself and other touch tablet competitors in this increasingly lucrative market.

Addendum:
Jared Sinclair, an ICU nurse in Nashville TN, has a similar view on the topic,

Couple of weeks ago, my T-mobile contract expired and I turned to AT&T to get the iPhone. Was able to quickly sell my Blackberry (BB) Pearl on Craigslist (really like that service) and am slowly getting use to the iPhone quirks.

What I don’t like, miss or just haven’t gotten use to on the iPhone:

Cut n’paste – iPhone just doesn’t do it in any easy fashion.

Ease of adding contacts – Couple of steps and you are done on the BB, not nearly as simple on iPhone.

Email handling – iPhone is adequate with more “parsed” architecture of handling email clients. The BB served all the emails up in one concise view.

What I like about the iPhone:

Great interface – manual, what’s that? All product designers HW or SW should strive to create products that don’t need a manual.

Accessing the Web – I knew that this would be good but had no idea it would be this good. Have now gotten into the practice of not only reviewing emails on my subway ride into the office, but now easily open links and review articles sent to me and through Twitterfon, can review all the latest news from those I follow.

App Store – So many apps, so little time. Have only just begun to explore the App Store, paying special attention to those apps focusing on Health & Wellness and Medicine (though admit to downloading a few games). Have certainly not gone through and demo’d all 800+ apps in these 2 categories, but beginning to look at some of the popular or more interesting ones (e.g. Epocrates, WebMD, My Life Record, etc.)

Of the health-related apps that I have tried to date, really impressed with Epocrates. Little wonder that it remains one of the most popular Apps on the App Store and is the most popular free app under “Medicine”.